therapy is appropriate in patients who
have severe symptoms at the initial
Figure 2 Potts Puffy Tumour. Note the
swelling over the central forehead.
Photo: Courtesy of Mr Andrew Robson,
ENT Consultant).
needs to be interpreted with caution as
its sensitivity is less than 50% in
children and 70-90% in adults. There is
secondary bacterial infection in 30% of
IM cases, hence the need for antibiotics.
Ampicillin needs to be avoided as it may
lead to severe allergic rash. In case of
significant tonsillar swelling, affecting
the airway, one may prescribe a short
course of systemic steroids.
Management of acute tonsillitis is mainly
supportive with adequate analgesia and
hydration. A Cochrane review of
antibiotic use for sore throat shows
benefit of reducing illness by 1 day and
reduction of chance of developing
quinsy. Although universal use of
antibiotics is not justified, antibiotic
assessment and in those who show no
signs of improvement within 48-72
Tracheostomy is rarely required as the
inflammation settles down within a few
days and the patient can be extubated
safely. Medical management includes
intravenous antibiotics (eg
thirdgeneration cephalosporins),
intravenous fluid and steroids, blood
culture, throat swabs and transfer to a
high dependency unit or an intensive
care unit. Patient usually responds
within 24-48 hours and can be
extubated.
Salivary gland infections: Mumps
(commonly caused by para myxovirus)
is the most common cause of non-
suppurative infection of the parotid
gland in children. It causes bilateral
tender parotid enlargement, trismus and
malaise. Treatment is conservative
Recurrent non-suppurative sialadenitis
of parotid and submandibular salivary
glands is secondary to obstruction of the
ducts (due to stones, strictures or
mucous plug). Clinically, patients
complain of painful swelling of the gland
when eating Treatment is conservative
(i.e. massaging the gland, hydration and
sialagogues) or in recurrent cases
involves sialo-endoscopy. stone
extraction or duct dilatation.hours.
Indications for admission are rare, and
include absolute dysphagia, upper
airway obstruction and failure to improve
at home.
Acute tonsillitis can lead to peritonsillar
abscess (quinsy). deep neck space
infections and, very rarely, scarlet fever,
rheu. matic fever and
glomerulonephritis. Quinsy is
characterized by marked trismus,
unilateral peritonsillar swelling and
deviation of uvula to the opposite side.
Quinsy is managed by needle aspi
ration and/or incision and drainage of
the abscess along with intravenous
antibiotics, steroids and fluid
replacement (Figure 3).
Acute supraglottitis is a bacterial
infection in children between 2 and 7
years characterized by sore throat. high
temperature, drooling associated with
progressive inspiratory stridor
secondary
inflammation of supraglottis (mainly of
the loose connective
Suppurative staladenitis can be acute or
chronic. Acute bac t erial sialadenitis is
commonly seen in dehydrated
immunocompromised patients and
caused by retrograde contamination
from the oral cavity characterized by
painful swollen salivary gland, pyrexia
and purulent discharge from the ductal
ontice. Investigations include ultrasound
to rule out any abscess for mation or
any obvious duct obstruction Sialogram
is often employed after the acute phase
has subsided to look for duct pathology
but it can treat the problem by flushing
the duct. Management involves
intravenous fluid and antibiotics
(commonly co-amoxiclav). In the event
of abscess formation, surgical drainage
is required. Recurrent acute
sialadenitismay also require surgical
removal of the gland.